It’s estimated that 12% of women will develop major depression within a year of giving birth, and nearly 19% acquire minor forms of the illness. Postpartum depression disrupts maternal-infant bonding and can damage the infant’s behavioral and cognitive development. Unfortunately, many at-risk mothers don’t get diagnosed until the disease is present and established.

A new simple screening test has been devised to identify women at risk for postpartum depression. A small prospective study taken recently showed that 91% of mothers who scored 6 or above on the Modified Fatigue Symptom Checklist 14 days after giving birth had an increased risk of developing postpartum depression.

Dr. Elizabeth Corwin, Ph.D., who is an associate professor of nursing at Ohio State University, says, “We found that fatigue and not a history of stress or depression is the best indicator of which women will go on to develop postpartum depression.” Corwin is the lead author of the study, a report of which appeared in the Journal of Obstetric, Gynecological, and Neonatal Nursing last fall.

The study of 31 women all between 36 and 38 weeks gestation completed questionnaires on fatigue, stress, and symptoms/history of depression; they also had their cortisol levels measured. This was repeated at one, two, and four weeks following birth.

After the fourth week, 11 of the 31 women reported having depressive symptoms. Seven of these women had family histories of depression, four of whom also had a personal history with depression.

According to Corwin, “A personal history of depression is an excellent way to predict which women are at risk for postpartum depression. Still, using that as the sole screening tool would have left seven of the women undiagnosed. Likewise, a family history of depression is a risk factor, but by using family history alone, we would have missed four women who went on to develop signs of depression.”

The study’s most significant result was that 10 of the 11 women (91%) who showed symptoms of postpartum depression during the fourth and final week of the study also reported higher-than-normal levels of fatigue two weeks prior. Only one out of the group of 11 went on to demonstrate depressive symptoms without reporting excessive fatigue at that visit.

While these women reported they also felt overly stressed beyond normal levels, elevated stress levels based on the women’s answers to the stress questionnaire weren’t sufficient to predict which women would ultimately develop postpartum depression. Most of the women in the study reported higher-than-usual levels of stress during the first month postpartum.

Also, cortisol levels were highest for all the women in the study at the end of their pregnancies and steadily declined during the month after they gave birth. This ruled out using cortisol levels to indicate differences in stress between women later developing depression, and those that did not go on to develop depression.

Other researchers have suggested that fatigue is an initiating factor or contributor to postpartum depression, and Corwin said she is not the first to suggest that, but their data were from retrospective studies. Dr. Corwin is believed to be the first to study mothers prospectively.

She states, “All mothers are tired after having a baby, but for some women the fatigue is relentless, and it is very hard to try to be a good mother and take on the new role when you are so exhausted. Little by little I think these moms don’t respond to their babies because they are so tired, and eventually the babies won’t respond to the mothers. Even if the mom does begin to respond later, she is out of sync with the baby from symptoms of depression.”

The study was undertaken by Corwin and colleagues at Pennsylvania State University.

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